Early Learning Program enrollment | Megaminds Learning center

1 Child’s basic information

Allergies & anaphylaxis risk

List all food, drug, insect, and environmental allergies. If none, write “None known.” Staff use this for meals, first aid, and emergencies.

Allergies (be specific) *

2 Parent / guardian details

Complete for each legal guardian. Leave secondary blank if not applicable.

Parent / guardian A

Full legal name *

Phone (primary) *

Phone (backup)

Email *

Relationship to child *

Home address *

Work address

Preferred contact method *

Government ID reference (type + last 4 if required)

Have you filed the DOI for the 2025-2026 school year for your student? *

Child's Living Arrangement *

Both parents Mother Father Other:

Child's Legal Guardian *

Both parents Mother Father Other:

Parent / guardian B (optional)

Full legal name

Phone (primary)

Phone (backup)

Email

Relationship to child

Home address

Work address

Preferred contact method

Government ID reference

3 Emergency contacts (other than parents)

Provide at least one trusted adult we may call if parents are unreachable.

Emergency contact 1 *

Full name

Phone

Relationship to child

Authorized to pick up this child from the center when listed on the pickup roster and ID is verified.

Emergency contact 2

Full name

Phone

Relationship to child

Authorized to pick up when rostered and ID verified.

4 Authorized pickup list

Anyone not on this list will not be released without parent approval. Photo ID is required at pickup unless you note an exception below.

Photo ID at pickup *

Custody / legal restrictions on pickup

Authorized individuals (add as many as needed; attach sheet if more than four)

Person 1 * Phone * Relationship to child

Person 2 Phone Relationship to child

5 Medical information

Is your child one of the following: *

Fully Vaccinated Unvaccinated

Pediatrician name *

Pediatrician phone *

Health insurance (optional)

Immunization records *

Upload a copy or list dates; state licensing may require current records.

Known medical conditions

Medications & dosage instructions

Special needs or care instructions

6 Emergency & consent forms

I authorize emergency medical treatment for my child if I cannot be reached and a physician determines care is necessary. * I consent to basic first aid (bandages, ice, fever monitoring, etc.) by trained staff. * I consent to emergency transportation (e.g. ambulance) if recommended by first responders or medical staff.

Preferred hospital / ER (optional)

7 Daily care information

Are disposable or cloth diapers/pull-ups used? *

Disposable Cloth Does not apply to my child

Is there a frequent occurrence of diaper rash? *

Yes No Maybe: Lets monitor and see Does not apply to my child

Are bowel movements regular? *

Yes No

How many per day? *

Is there a problem with:

Diarrhea Constipation Both Neither

Has toilet training been attempted? *

How does your child indicate bathroom needs (include special words)? Is your child ever reluctant to use the bathroom? Does the child have accidents?

Sleeping habits

Does your child sleep in a crib or bed? *

Crib Bed

Does your child become tired or nap during the day (including when and how long)?

When does your child go to bed at night and get up in the morning? *

Describe any special characteristics or needs (stuffed animal, story, mood on waking etc.)

Feeding schedule

Dietary restrictions & preferences

Nap schedule

Toileting status

Comfort items from home

8 Behavioral & developmental notes

Behavioral concerns or triggers

Developmental milestones or delays

What calms or upsets your child

9 Program & legal agreements

All students enrolling must pay a non-refundable $75 registration Fee. If you are ready to sign up please answer Yes below and a link to pay will be sent with the form to sign up for classes. *

Yes, I am ready to sign up my student and will pay the non-refundable registration fee. No, I am not ready to sign up my student or pay the non-refundable registration fee and understand that spaces are limited.

By checking below you acknowledge review of the listed documents. Signed PDFs may be required separately per center policy.

I have received and agree to the enrollment contract (fees, hours, holidays, termination, late pickup policy). * I accept the liability waiver as provided. * Photo / video consent for classroom app updates (uncheck for no classroom photos of your child). Optional: consent for marketing / website use of photos (separate from daily app updates). Field trip permission for walking trips or vehicle trips as described in the parent handbook.

10 Check-in / check-out system data

Your center may record the following electronically. Confirm how signatures and verification should work.

Preferred verification at pickup *

Notify when child is picked up?

Notes for staff (drop-off / pick-up routines)

Recorded at the center: who dropped off or picked up, timestamps, and signature or digital verification are stored per state regulations and your parent handbook. You may request a copy of your data at any time.